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A Nursing Manifesto for 2030: Human Care Against Extraction and Exploitation (green paper)

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Renata E. Mares MIPH, BScN, BA Kin

Aug 22, 2026

Please use this document in any way that you wish. You can freely use this document (with citation; see our creative commons license in the footer of this and all pages on this site)  The format for citing the document is shown at the end of the table of contents. If you wish to have other ideas integrated into this document, or included on this web site, please contact us or the author directly renata@adaptablefolks.com

1.     Introduction
2.     Planetary Health is Nursing Work
3.     Commercial Determinants of Harms and Health: Get Political  
4.     Nursing Is Not a Buffer for System Failure
5.     Against the Medical-Industrial Complex
6.     Our Commitment
7.     A Call to Conscience and Action
8.     About the Author
9. Reference list (see image)

Citation: Mares, R. E. (2026). A Nursing Manifesto for 2030: Human Care Against Extraction and Exploitation (green paper). https://nursemanifest.com/2026/08/31/a-nursing-manifesto-for-2030-human-care-against-extraction-and-exploitation-green-paper/

Foreword

I came across this incredible blog post about A Nursing Manifesto 2000 written by three incredible nurses and academics: Richard Cowling, Peggy Chinn, Sue Hagedorn in 2000 and I thought to develop a parallel manifesto which brings together some of the books I have been reading over the past 5 years post-pandemic and some which reaches further back to the 80s 90s, 2000s, till present time.

The world have shifted quite a bit since this manifesto was developed and shared. In and of itself, it reads like something to aspire to. Maybe when I started my nursing career as a new graduate back in 2008, it would have been something to aspire to in my own work, career, research and teaching. But now I find some pretty troubling things not only missing from this manifesto as historical accounts, including the troublesome origins of the nursing and medical profession / culture, but it needs to be updated for the year 2030 and beyond.

But first, take some time to read and get familiar with A Nursing Manifesto 2000: https://nursemanifest.com/a-nursing-manifesto-a-call-to-conscience-and-action/

Below is the introduction to A Nursing Manifesto: A Call to Conscience and Action written in 2000. I am sharing here just the initial Introduction, but please do have a read of the entire manifesto as it discusses the ideals and principles, inspiration, concerns, vision and suggestions for actions. It also describes the authors and their positionality and about the art contained within this blog.

A Nursing Manifesto: A Call to Conscience and Action (2000)

by Richard Cowling, Peggy Chinn, Sue Hagedorn

Introduction (excerpt)

“As nurses, we reach for meaningful expressions of our values, too often finding overwhelming constraint and resistance, sometimes within ourselves and sometimes imposed from without. We are calling for a movement to awaken those precious and powerful ideals that are rooted in nursing’s worldwide historical traditions. We call forth the written and spoken voice of nursing to be claimed and reclaimed. We seek to inspire the fullest expression of the heart of nursing through individual and collective acts. We believe there are profound possibilities in claiming our individual and professional sovereignty” … link to full manifesto here: https://nursemanifest.com/a-nursing-manifesto-a-call-to-conscience-and-action/#intro

My initial thoughts on this this first paragraph would be:

  • Awakening the so called ‘precious and powerful ideals’ is definitely a good thing, but how does nursing as a profession and value-based career wrestle with the monolith it has created the lack of diversity over the course of centuries
  • Rooted in nursing’s worldwide historical traditions: would these discuss how Nightingale-like nursing is rooted in supporting war and military efforts? Would these traditions address the issues of explicitly racism, sexism, and harmful medical cultural administrative practice over the course of the centuries? Our current professional associations are build as empires where lack of diverse leadership opportunities persist and patriarchal hierarchies are celebrated as excellence.
  • Attrition in nursing and healthcare is at crisis levels, yet no one talks explicitly about trauma and cPTSD experienced not from patients, toxic teams, but administrative and regulatory practices. Anyone care to elaborate here?

As I was reading this incredible manifesto and remembering back to the year 2000, I started to draw both parallels and the need to advance these exact thoughts to the years 2030 and beyond. At first I had the idea of taking each section and paragraph and write my thoughts in support and opposition. But then I thought, why not take all that I have read and know and develop something totally new yet complementary. Building upon my elders’ work.

Believe it or not, I have a fear of writing my own voice and ideas down. I don’t want to hurt feelings and I do get intimidated by folks who are much more qualified than myself, and therefore, I have the feeling that maybe I should not share what I have to say. I am now slowly building back my lost confidence and also recognizing that part of nuanced and critical thinking is (sometimes) getting things wrong, and sometimes right but too soon. So, I want to share both what I might be thinking that is wrong and also my worries about the nursing profession that I love so much. After nearly 20 years in this profession across specialties like orthopedic/trauma, medical/surgical units, mental health, public and community health, policy and education, I feel that I did my authentic best in trying to build the new and not getting lost in the challenges of the past. However, burnout happens to all of us, some more resilient than others. I am accepting that I might have pushed too hard for change and lacked the skills of relationship building. My past of being a refugee and immigrant female child who grew up in post-Communist Romania and Hungary could add to some of these reasons. The urgency to alleviate struggles for others was a real cause and drive for me. I never understood how a bunch of smart people could just sit around the table and talk about action, while people were struggling. Access to healthcare is access to people’s tax dollars. Talking was seemingly a waste of time from my perspective, as an early career public health nurse. I was searching to find people who felt the same urgency (or at least understood my motivations) as I did to act and help get folks out of poverty, get access to health and social services, and not just talk about it in meetings.

I may have been naïve and rushed. I was give the privilege of a profession to do good and alleviate harms. However, without trusted relationships, money doesn’t flow and people remain in poverty, in struggles that are the result of structures and systems I wanted to adapt. Some lessons we learn the hard way. I am now re-learning to build the confidence to talk, share ideas, and build relationship among people who are looking to advance the only huma-centered profession still remains. (I might be biased in this view) Is the last human job a nurse? Or so I assume in this manifesto. Or maybe the last human jobs are human-collaborations across sectors. Yes, that sounds more like it. But first we need to pivot (yes, just like that couch on a Friends episode from Feb 1999) and pay those human-collaboration jobs a fair wage.

Therefore, I am using my LinkedIn platform to share my ideas of A Nursing Manifesto for 2030: Human Care Against Extraction and Exploitation – a draft (2026) paralleling what has been written in 2000 and adding in some of my ideas from the list of resources that I will share at the very end of this writing. It might give future nurses in undergraduate and graduate studies something to ponder beyond the status quo of the nursing/ healthcare profession and education. We need to get out of ‘our’ status quo cultural box.

As always, I am open to discussions and opposing views that are shared respectfully.

1. INTRODUCTION

‘We’ are nurses (diverse with complex/ adaptive skills professionals) at a time when care is being remade by machines, markets, and systems that measure human worth in data points, risk scores, productivity targets, and billing codes.

We do not reject technology.

We reject technology without accountability.

Artificial intelligence, automation, surveillance, and predictive systems have entered hospitals, homes, clinics, long-term care, and public health. They promise efficiency while too often deepening abandonment. They sort people by profitability, automate denials, intensify workloads, erase human judgment, and place the burdens of flawed systems on those already made vulnerable by racism, colonialism, poverty, disability, gender oppression, and displacement.

We have seen what happens when an algorithm is treated as neutral while it inherits the inequities of the world that trained it. We have seen staffing systems call exhaustion as ‘optimization’. We have seen virtual care become a substitute for accessible, relational care. We have seen automation used not to relieve nurses of harmful labour, but to eliminate jobs, deskill practice, and demand that fewer workers do more with less.

This is not innovation.

It is extraction.

We are nurses practicing amid converging emergencies: widening inequality, climate breakdown, poisoned water, forced displacement, worsening chronic illness, automated exclusion, and healthcare systems increasingly governed by commercial interests rather than public need.

We affirm that health is inseparable from the conditions in which people are born, grow, work, live, age, and die. Health begins with breathable air, safe homes, nourishing food, clean water, meaningful connection, cultural continuity, freedom from violence, and a stable living planet. No hospital, algorithm, drug, or procedure can compensate for a society that systematically destroys these foundations.

The medical-industrial complex has transformed illness into revenue, crisis into market opportunity, and health into a commodity distributed according to wealth, insurance status, postal code, citizenship, and institutional power. It profits from endless treatment while neglecting clean air, safe housing, food security, living wages, disability justice, mental health, reproductive freedom, and the conditions that allow people to live well before they become patients.

We reject the fiction that health care exists apart from the world. The same systems that commodify illness extract from workers, communities, lands, and waters. The medical-industrial complex profits from treatment while underinvesting in prevention; corporations profit from pollution while public systems absorb the resulting disease; technology firms market “innovation” while shifting social, environmental, and clinical risks onto patients, caregivers, and frontline workers.

This is not an accident. It is a political choice.

We refuse to accept a healthcare system that calls itself advanced while people wait in pain, workers burn out and become patients themselves (Chapman, 2023), communities are poisoned, and the planet warms. (Check out the underlying drivers of planetary harms by Planetary Health Alliance website: culture, values, behaviour, consumption, population size/demographic changes, technology) https://planetaryhealthalliance.org/what-is-planetary-health/

Nursing must be more than the human face placed on an inhumane system. Our role is not to make austerity appear compassionate, to absorb the moral injury created by unsafe conditions, or to quietly compensate for decisions made by executives, insurers, technology firms, regulators and governments far from the bedside.

Our ethical obligation is to care and to confront what makes care impossible.

2. Planetary Health is Nursing Work

Planetary health is not an optional specialty or a future concern. It is present in every heat-related illness, asthma exacerbation, contaminated water supply, food insecurity assessment, infectious-disease outbreak, wildfire evacuation, pregnancy complication, mental-health crisis, and preventable death.

We recognize the health of people as inseparable from the health of lands, waters, ecosystems, and climate. Indigenous peoples have long carried knowledge of these relationships and of stewardship, reciprocity, and collective responsibility. Nursing must listen, learn, and act without appropriating that knowledge or repeating colonial systems of control.

We will advocate for health systems that reduce rather than export harm: low-carbon care, ethical procurement, less waste, resilient infrastructure, safe transportation, sustainable food systems, and emergency planning led with (not imposed upon) affected communities.

Clean water is a health right, not a commercial asset. Water insecurity, contamination, privatization, boil-water advisories, drought, flooding, and inadequate sanitation are nursing concerns because they produce infection, chronic disease, reproductive harm, trauma, displacement, and death. We will name water injustice as a clinical and public-health emergency, especially where it follows colonial dispossession, industrial pollution, and neglect of rural, remote, and Indigenous communities.

3. Commercial Determinants of Harm and Health: Get Political

We confront the commercial determinants of health: the corporate practices that shape exposure to harm, access to care, public policy, and the very definition of health.

Industries profit when people consume products that damage their bodies or environment, including tobacco and nicotine corporations, alcohol producers, ultra-processed food companies, fossil-fuel industries, extractive mining interests, pharmaceutical monopolies, private equity firms, surveillance platforms, and vendors of unaccountable health technology, and digital-addictive designs and digital-afterlife industries. Their influence reaches advertising, research, regulation, education, political lobbying, clinical guidelines, and data infrastructure.

We reject the normalization of harm as “consumer choice” when choices are engineered through marketing, pricing, scarcity, misinformation, racism, design inequity and unequal power.

We also recognize that commercial power can shape health positively only when it is democratically governed, transparent, and subordinated to the public good. Products, technologies, and services must be assessed not simply by revenue or technical novelty, but by their effects on equity, ecological sustainability, worker safety, community control, and long-term health. (my favourite slogan: war brings neither peace nor climate justice, defund military spending).

4. Nursing Is Not a Buffer for System Failure

Nursing is not low-paid emotional labour designed to absorb the failures of health and social systems. It is not a flexible reserve workforce to be stretched during crises, disciplined through precarity, or replaced by automation when budgets demand it.

Nursing knowledge is scientific, relational, ethical, political, and ecological. Nurses assess changing conditions, interpret uncertainty, build trust, notice patterns others miss, coordinate care across fragmented systems, protect rights, respond to suffering, and advocate for structural change. This expertise cannot be reduced to tasks, scripts, dashboards, or a layer of “human oversight” added after an algorithm has already shaped a person’s options.

We reject the use of artificial intelligence and automation to intensify work, monitor workers, remove professional judgment, automate benefit or treatment denials, or redirect accountability away from corporations and institutions. A nurse must never be expected to legitimize a harmful system simply because a person remains nominally “in the loop.”

Technology must serve care, not govern it. Any system used in health care must be transparent, independently audited, accessible, privacy-protective, environmentally accountable, and open to challenge by patients, families, nurses, and communities. It must be assessed for bias, labour impacts, energy and water use, supply-chain harms, and effects on access, not only for accuracy or cost savings.

5. Against the Medical-Industrial Complex

The medical-industrial complex converts suffering into revenue. It treats health as a market, patients as customers, records as assets, and workers as costs to be minimized. It normalizes private equity, monopolies, predatory pricing, medical debt, pharmaceutical profiteering, commercialization of data, and the outsourcing of public responsibilities to corporations.

We refuse a health system that boasts of technological progress while people cannot obtain primary care, medication, safe housing, home care, reproductive services, mental-health support, palliative care, or culturally safe care.

We oppose austerity disguised as efficiency. We oppose privatization disguised as innovation. We oppose surveillance disguised as safety. We oppose extraction disguised as care.

A just health system must be universal, public, adequately funded, community-rooted, culturally safe, accessible, and accountable to the people it serves. It must invest upstream: in income security, public housing, education, food sovereignty, disability justice, harm reduction, clean water, healthy ecosystems, and meaningful public-health capacity.

6. Our Commitment

We therefore commit ourselves to:

  • Defend human dignity over speed, profit, automation, and institutional convenience.
  • Defend health as a collective right and reject its treatment as a commodity.
  • Identify and confront commercial practices that produce illness, environmental destruction, inequity, and barriers to care.
  • Follow the leadership of communities most affected by environmental injustice, commercial exploitation, and institutional neglect.
  • Insist that every artificial intelligence system used in health care be transparent, independently audited, explainable, contestable, and governed with meaningful public and worker participation.
  • Refuse algorithms that reproduce discrimination or replace clinical judgment, informed consent, and relationships of trust. Stand against racism, colonialism, ableism, sexism, homophobia, transphobia, class exploitation, and xenophobia in health systems and society.
  • Demand that technology reduce harmful work and expand access to care, not intensify surveillance, cut staffing, deskill nursing, or deny services. My post on nursing profession and branding https://www.linkedin.com/feed/update/urn:li:activity:7496682545108025345/
  • Organize for safe staffing, fair wages (like programmers and coders once were paid), public health infrastructure, union rights, and workplaces where nurses can speak honestly without retaliation (regulatory harms have still not been addressed explicitly and attrition continues to crisis levels). My post on trauma: https://www.linkedin.com/feed/update/urn:li:activity:7496346149822287873/ ; my post on regulatory harms https://www.linkedin.com/feed/update/urn:li:activity:7496353936921071616/
  • Treat climate disruption as a health emergency created by unequal systems of extraction, and advocate for care that protects communities and the living world.
  • Stand with patients and communities against medical debt, privatization (yes Canada, you too), predatory pharmaceutical practices, corporate consolidation, and the commodification of suffering (CDoH, 2022). post on global power demand by 2030 https://www.linkedin.com/feed/update/urn:li:share:7255265303691997184/
  • Advocate for public, universal health systems free from corporate capture and private-profit priorities.
  • Center the knowledge and leadership of Indigenous peoples, Black communities, disabled people, migrants, low-income communities, and all those harmed first and worst by unequal systems. (Can we please collect wealth tax, and stat? Harrington, 2025)
  • Protect the right of every person to understand, question, and refuse the technologies affecting their body, records, treatment, and future. (Once people lose mental capacity, at any age, what happens to their digital footprint and logins. Read up on digital-afterlife industry) my post: https://www.linkedin.com/feed/update/urn:li:activity:7496323674120048640/
  • Practice solidarity across professions, sectors, and borders, because no individual nurse can solve harms produced by structural power.
  • Protect clean water, sanitation, healthy ecosystems, and climate stability as indispensable conditions of health.
  • Treat nursing expertise as essential to governance, policy, technology design, climate adaptation, public health, and community-led care, not as inexpensive labour or an afterthought in executive decisions.
  • Build care systems based on solidarity, reciprocity, prevention, justice, and ecological repair.

7. A Call to Conscience and Action

In 2030, conscience requires more than compassion.

It requires courage. Not only to speak for/with patients, families and communities, but to speak against professional toxic culture, leadership, and stagnant professional envelopment. It requires collective action against the systems that manufacture illness and call the consequences unavoidable.

It requires us to ask not only, “Can this technology be used?” but “Who does it serve? Who exposed to/ bears its risks? Who profits? What forms of care, labour, and life does it displace?” Who is left waiting, excluded, displaced, or silenced?

I have held a role as a nurse informatics, merging duplicate files because IBM refused to adapt their infrastructure. Are informatics professionals seen as human-in-the-loop or human-exploited-in-the-loop?

It requires us to understand that a healthy society cannot be built on exhausted workers, disposable patients, automated exclusion, or a damaged planet. We CAN however, pivot workforce roles and pay people to do human jobs, like witnessing and delivering care where it’s needed. (Pugh, 2026)

Care cannot be ethical if it relies on ecological destruction. Innovation cannot be just if it is built on surveillance, dispossession, or underpaid labour. Health cannot exist where water is unsafe, homes are unaffordable, ecosystems are collapsing, and human needs are subordinated to corporate return.

We will not be reduced to exhausted labour, automated compliance, or human cover for decisions made by machines and markets.

We call on nurses to reclaim our collective (yet, diverse) voice. We call on health workers to organize. We call on institutions to place care above revenue (wealth tax helps here). We call on governments to regulate health technologies in the public interest and to fund universal, accessible, community-rooted health care.

We call on the public to reject a future in which the right to health is determined by an algorithm or a balance sheet.

Care is not a product. Health is not a privilege. People are not (just) data to be extracted and sold.

The planet is not expendable.

We will not be silent witnesses to systems that harm in the name of progress.

We will practice, organize, resist, and build a future in which care remains human, collective, just, and sustainable.

We are nurses. We are advocates, clinicians, educators, organizers, researchers, knowledge holders, and defenders of the conditions required for life.

We will care for people and we will fight for the world in which people can be well.

8. About the Author

The Nursing Manifesto 2030 builds upon and expands The Nursing Manifesto 2000, the pioneering work of Richard Cowling, Sue Hagedorn, and Peggy Chinn. In the age of AI, provenance is one of the most important forms of acknowledgement, demonstrating that ideas and thoughts never simply appear, but are cultivated, grazed, turned over, and digested with time, patience, and communal support. The original authors all came from white, middle-class backgrounds and grew up in diverse regions of the United States (New York, Hawaii, Virginia), with relatively privileged access to education, travel, and cultural experiences. Yet early in their lives, each followed personal and political paths that challenged the status quo, often to the chagrin of family and friends. Though not always overtly “political” on the surface, their journeys reflected a deep yearning for peace, justice, and the caring, nurturing values they perceived to be at the heart of nursing. They came together to prepare the text for A Nursing Manifesto 2000, informed by their shared awareness of the deeply political nature of personal choices.

Renata E. Mares, author of The Nursing Manifesto 2030: Human Care Against Extraction and Exploitation (green paper), brings both continuity and distinct difference to this legacy. Born in 1984 in Oradea, Romania, a region marked by Hungarian legacies and Romanian cultural tensions since the 1920s (Treaty of Trianon), she became a refugee at age four when her family fled the communist regime in 1988. She grew up in post-communist Hungary (schooling) and Romania (summer vacations), experiences that shaped her social justice and ethical compass, and led her to challenge oppressive and racist systems throughout her nursing career. Her father and brother spend fiver years (1990-95) in Rochester, New York in hopes for her mother and herself to follow but at that time families could not easily join. Her family immigrated to Guelph, Ontario, Canada in 1996 and has called this place home even across her decades of travel and nursing. Since nursing school in Canada (2003–2008) and continuing through diverse roles in ortho-trauma, med-surg, rehabilitation, mental health, long-term care, public health, outbreak management, policy consulting, education, and global humanitarian work (2009–2019), she has consistently challenged the status quo, even when it meant alienating friends, colleagues, and family. Today, she firmly believes nursing remains the most human-centered profession, uniquely positioned to challenge profiteering practices, build regulatory and safety guardrails through healthy public policy, and resist automation of human-care work. Grateful to the original manifesto authors for helping her articulate the political nature of her own choices, she writes in hopes that reflection, awareness, and philosophy will offer others the same healing she has found through two decades of honest practice in nursing and across the health system.

9. References

Alicia Wanless. The Information Animal: Humans, Technology and the Competition for Reality. 2025. https://academic.oup.com/book/61821.

Alison Pugh. The Last Human Job. 2026. https://press.princeton.edu/books/hardcover/9780691240817/the-last-human-job?srsltid=AfmBOoq_JMH6DnzyIEP2cMrGLQaAsBUtcxJWMy439dXRkiXxKJRId0CX.

Arthur Allen. Vaccine: The Controversial Story Of Medicines Greatest Lifesaver. WW Norton, 2008.

“Automating Inequality.” Virginia Eubanks, August 19, 2017. https://virginia-eubanks.com/automating-inequality/.

Bartlett, Cheryl, Murdena Marshall, and Albert Marshall. “Two-Eyed Seeing and Other Lessons Learned within a Co-Learning Journey of Bringing Together Indigenous and Mainstream Knowledges and Ways of Knowing.” Journal of Environmental Studies and Sciences 2, no. 4 (2012): 331–40. https://doi.org/10.1007/s13412-012-0086-8.

Bessel van der Kolk. The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Penguin Books Canada Limited, 2015.

Brian Evergreen. Autonomous Transformation: Creating a More Human Future in the Era of Artificial Intelligence. 2023. https://www.amazon.ca/Autonomous-Transformation-Creating-Artificial-Intelligence/dp/1119985293.

Brooke Harrington. Offshore: Stealth Wealth and the New Colonialism. 2025. https://www.penguinrandomhouse.ca/books/773970/offshore-by-brooke-harrington/9781324110323.

Cory Doctorow. The Reverse Centaur’s Guide to Life After AI. 2026. https://www.versobooks.com/en-ca/products/3584-the-reverse-centaur-s-guide-to-life-after-ai.

Costanza-Chock, Sasha. Design Justice: Community-Led Practices to Build the Worlds We Need. Information Policy, edited by Sandra Braman. MIT Press, 2020. https://mitpress.mit.edu/9780262043458/design-justice/.

Daniel Susskind. “A World Without Work.” Accessed August 22, 2026. https://www.danielsusskind.com/a-world-without-work.

David Graeber and David Wengrow. The Dawn of Everything. 2023. https://www.penguinrandomhouse.ca/books/616885/the-dawn-of-everything-by-david-graeber-and-david-wengrow/9780771049842.

Emily M. Bender and Alex Hanna. The AI Con: How to Fight Big Tech’s Hype and Create the Future We Want. 2025. https://thecon.ai/.

Gabor Maté. When the Body Says No: The Cost of Hidden Stress. 2004. https://drgabormate.com/book/when-the-body-says-no/.

Gary Slutkin. The End of Violence. 2026. https://www.hachettebookgroup.com/titles/dr-gary-slutkin-md/the-end-of-violence/9780316520119/.

Gregory P. Marchildon. Tommy Douglas and the Quest for Medicare in Canada. 2024. https://utppublishing.com/doi/book/10.3138/9781487560430.

Haun Saussy, ed. Partner to the Poor: A Paul Farmer Reader. 1st ed. University of California Press, 2010. https://www.jstor.org/stable/10.1525/j.ctt1ppcmr.

“Invisible Women | Caroline Criado Perez.” Accessed August 22, 2026. https://carolinecriadoperez.com/book/invisible-women/.

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Karen Hao. Empire of AI. Penguin Random House Canada. 2025. https://www.penguinrandomhouse.ca/books/743569/empire-of-ai-by-karen-hao/9780593657508.

Leanne Betasamosake Simpson. Theory of Water: Nishnaabe Maps to the Times Ahead. 2026. https://www.leannesimpson.ca/portfolio-books/theory-of-water.

Linda McQuaig and Neil Brooks. Cancelling Billionaires Before They Cancel Us. 2026. https://www.dundurn.com/books_/t22117/a9781459754836-cancelling-billionaires-before-they-cancel-us.

Maude Barlow. Profit Is Not the Cure by Maude Barlow | Penguin Random House Canada. 2011. https://www.penguinrandomhouse.ca/books/8670/profit-is-not-the-cure-by-maude-barlow/9781551995267.

Maude Barlow and Tony Clarke. Blue Gold : The Battle Against Corporate Theft of World’s Water. 2003. https://www.penguinrandomhouse.ca/books/8669/blue-gold-by-maude-barlow-and-tony-clarke/9780771010866.

Mehra, Natalie, and John Cartwright. “Profit Is Not the Cure.” The Council of Canadians, April 12, 2024. https://canadians.org/analysis/profit-is-not-the-cure/.

Nason Maani, Mark Petticrew, and Sandro Galea. The Commercial Determinants of Health. Oxford University Press, 2022. https://academic.oup.com/book/44473.

Noral Loreto. Corporate Control. 2025. https://www.dundurn.com/books_/t22117/a9781459753136-corporate-control.

Paul Farmer. AIDS and Accusation: Haiti and the Geography of Blame. 2nd ed. University of California Press, 2006. https://www.jstor.org/stable/10.1525/j.ctt1pp3p4.

Paulo Freire. Pedagogy of the Oppressed. 50th ed. 2018. https://www.bloomsbury.com/ca/pedagogy-of-the-oppressed-9781501314162/.

Renee DiResta. Invisible Rulers. 2024. https://www.hachettebookgroup.com/titles/renee-diresta/invisible-rulers/9781541703377/?lens=publicaffairs.

Richard Cowling, Peggy Chinn, and Sue Hagedorn. “A Nursing Manifesto: A Call to Conscience and Action.” NurseManifest, 2000. https://nursemanifest.com/a-nursing-manifesto-a-call-to-conscience-and-action/.

Robert Chapman. Empire of Normality. 2023. https://www.plutobooks.com/product/empire-of-normality/.

Robin Wall Kimmerer. Braiding Sweetgrass: Indigenous Wisdom, Scientific Knowledge and the Teachings of Plants. 2015. https://www.amazon.ca/Braiding-Sweetgrass-Indigenous-Scientific-Knowledge/dp/1571313567.

Shoshana Zuboff. The Age of Surveillance Capitalism. 2019. https://www.hachettebookgroup.com/titles/shoshana-zuboff/the-age-of-surveillance-capitalism/9781610395694/?lens=publicaffairs.

Tim Ingold. Anthropology: Why It Matters. 2018. https://www.wiley.com/en-us/anthropology-why-it-matters-p-9781509519804.

Tina D. Purnat, Tim Nguyen, and Sylvie Briand, eds. Managing Infodemics in the 21st Century: Addressing New Public Health Challenges in the Information Ecosystem. Springer, 2023. http://www.ncbi.nlm.nih.gov/books/NBK609023/.

Vanessa de Oliveira Andreotti and Rene Suša. “Meta-Relationality Institute & Clearing the Field Series.” Meta-Relationality Institute, July 25, 2025. https://metarelationality.institute/about/.

Vanessa Machado de Oliveira. Outgrowing Modernity. 2025. https://www.penguinrandomhouse.ca/books/783178/outgrowing-modernity-by-vanessa-machado-de-oliveira/9798889842507.

“What Is Planetary Health?” Planetary Health Alliance, September 5, 2017. https://planetaryhealthalliance.org/what-is-planetary-health/.

(Potential) Rescheduling of Cannabis in the US: Policy, Process, and Patients

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Cannabis has been a DEA Schedule I drug since the initiation of the Controlled Substances Act (CSA) in 1970. Schedule I drugs are those classified as having a high potential for abuse and no known medical benefit. Cannabis has remained a schedule I drug despite the National Academies of Science, Engineering, and Medicines (2017) publication entitled The Health Effects of Cannabis and Cannabinoids, where NASEM concluded that there is substantial evidence for cannabis effectiveness in treating chronic pain, chemotherapy induced nausea and vomiting, and multiple sclerosis spasticity; moderate evidence around cannabis improving sleep with short term outcomes related to sleep apnea, fibromyalgia, chronic pain, and multiple sclerosis; and limited evidence around cannabis’s effectiveness with anxiety, PTSD, Tourette’s, IBS, TBI outcomes, dementia, glaucoma, and other neurodegenerative diseases. 

Because cannabis has remained a Schedule I drug, research has been greatly hampered, and the NASEM (2017) report called for the development of a national cannabis research agenda focusing on clinical and observational research, health policy and health economics research, and public health and public safety research. 

The NASEM report can be accessed here: https://www.ncbi.nlm.nih.gov/books/NBK423845/

Additionally, in 2003, the federal government issued a patent on cannabinoids related to the drug’s ability to help with healing from brain trauma and age-related brain changes. 

There is a lot of excitement in the medical cannabis world around the potential rescheduling of cannabis related to the US president’s December 18, 2025, executive order 14370 to reschedule cannabis. However, in 2024, the U.S. Department of Justice initiated a rulemaking process to begin the rescheduling process, and President Biden issued an executive order in 2022 directing the Department of Health and Human Services and the Department of Justice to review the rescheduling of cannabis. The DHHS in 2023 recommended that cannabis be moved to Schedule III, and in May 2024, the Attorney General signed off on a proposed rule to reschedule cannabis, which was also published in the Federal Register. This can be accessed here: https://www.federalregister.gov/documents/2024/05/21/2024-11137/schedules-of-controlled-substances-rescheduling-of-marijuana

However, an administrative law hearing is needed to formalize the process, and it has been stalled over the past year due to lawsuits alleging bias and procedural misconduct in the rescheduling process. Lawsuits include those from Doctors for Drug Policy Reform that allege they were excluded from the list of 25 designated hearing participants due to supporting rescheduling, Panacea Plant Sciences has sued the federal government because small cannabis businesses have been excluded from the hearings, Attorney Matt Zorn has claimed in a law suit that collusive communications occurred between the DEA and the anti-cannabis group Smart Approaches to Marijuana (focuses on the Freedom of Information Act), and a group of pro-rescheduling entities has been granted an interlocutory appeal based on the DEA being a proponent of the proposed rule. The interlocutory appeal has indefinitely stayed the rescheduling hearing process. Essentially, all of these lawsuits are focused on the concern that the DEA has stacked the witness selection process to ensure that cannabis remains a Schedule I drug in direct opposition to the DHHS recommendation that cannabis be rescheduled to Schedule III. The DEA and the DHHS have historically had differing views of DEA/ CSA scheduling. The current 2025 executive order does not address this issue; it does not provide a defined means to bypass the existing legal process, and the CSA of 1970 does not permit a President to unilaterally reschedule a drug. 

The only other approaches toward timely rescheduling of cannabis include an act of congress, which may be required to address the issues of banking concerns, research processes, and address the current conflicts between federal and state laws regarding cannabis. Additionally, Attorney General Bondi could expedite the process by bypassing the notice-and-comment process. 

There is a clear need for more medical cannabis research, and moving the drug to a schedule III would bypass researchers’ requirement to have a Schedule I license and the requirement to only access cannabis from a handful of government cannabis sources that may not provide access to quality cannabis products. Rules will need to be changed, and funding for cannabis research as a national public health agenda item will be initiated, with the goal of USFDA treatments being developed. By rescheduling, the reduced stigma associated with the prohibition of the cannabis plant may help to encourage academics, pharmaceutical companies, and cannabis businesses to engage in more cannabis research. Still, again, Congress will likely need to clarify or revise previous laws. For instance, Biden’s 2022 Medical Marijuana and Cannabidiol Research Act has not led to greater cannabis research because of the lack of access to the product, high costs associated with the security of cannabis products, lack of funding sources for research, and issues with federal law prohibiting the transfer of cannabis across state lines. 

Additionally, implications around what rescheduling means for cannabis producers, medical cannabis patients, and healthcare providers remain unclear. Cannabis being rescheduled does not change the federal legality of cannabis. It would still be a federally controlled substance, and currently, whether or not patients will be able to have cannabinoid therapeutics covered by insurance remains in question. While dronabinol, a synthetic THC medicine, is a Schedule III drug, it is only approved for CINV when other methods have failed, and loss of appetite and weight loss with anorexia and cachexia. It is not a first-line treatment for any health condition, although prescribing in pediatric settings appears to have increased over the years. Additionally, dronabinol may not be as therapeutically effective as whole-plant cannabis due to its lack of various cannabinoids, terpenes, and flavonoids that are found in whole-plant cannabis and may support optimal functioning of the body’s master regulator, the endocannabinoid system. 

While this process of rescheduling cannabis to Schedule III comes with a great deal of uncertainty and legal concerns, it is part of the process of ending the prohibition era of cannabis and entering into an era of cannabis regulation. Ideally, the patients who could benefit from access to cannabis and cannabinoid therapeutics are always at the forefront of benefits in the political process. Patients’ access to safe, tested, effective cannabinoid therapeutics remains a social justice issue, a research priority, and an advocacy concern for nurses. Nurses are ethically obligated to support patients’ autonomous right to access cannabinoids and to ensure that beneficence and nonmaleficence are upheld.

Resources

National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population Health and Public Health Practice; Committee on the Health Effects of Marijuana. (2017). An evidence review and research agenda. The health effects of cannabis and cannabinoids: The current state of evidence and recommendations for research.National Academies Press (US). https://www.ncbi.nlm.nih.gov/books/NBK423845/

https://alaskapublic.org/news/economy/2025-12-26/marijuana-rescheduling-would-bring-some-immediate-changes-but-others-will-take-time

https://mjbizdaily.com/news/great-leaps-in-cannabis-research-expected-after-marijuana-rescheduling/613762/

https://www.nbcnews.com/health/health-news/medical-marijuana-research-open-floodgates-cannabis-reclassification-rcna249811

Standing Up For Access to Vaccines in the United States

/ drcareyclark / Leave a comment

Written by Carey S. Cadieux, PhD, RN, AHN-BC, RYT, FAAN

As many of us struggle with the threats to public health under the current adminsitration, we may feel unempowered and discouraged. It’s important as patient and population advocates, and as the largest number of healthcare care providers, that we take steps toward finding small ways we can make a difference. Sharing our knowledge and calling for what is right for the health of the American people is something we can do in our everyday lives.

I have been greatly concerned about access to vaccines. For about a week in my state of New York, I haven’t been able to access a COVID vaccine as a prescription is required. For a number of reasons I couln’t obtain a prescription even though I have qualifying factors and I was about to travel to another state to obtain care until the Governor Hochul of New York wrote an executive order that ensures that all the people of New York State can receive a COVID vaccines without a prescription. Her executive order ensures that for the next 30 days, all NEw Yorkers can access a COVID vaccine, and the legislature will be charged with creating an official long term legislative move that will ensure access to all vaccines remain in place for New Yorkers. Ideally her actions alongside those of the governors of Massachusetts, California, and New Mexico will be replicated by other states.

Meanwhile, we have an opportunity to make our voices heard to the Avdisory Committee on Immunization Practices (ACIP) and the CDC prior to their next meeting in 7 days time. Until Spetember 13 @11:59 pm EDT, you can send a comment to the committee expressing your concerns the ACIP will be discusisng revisions to vaccines that can be adminstered to children and the vaccine schedule that dictates how ACA insurance is used (or not) to pay for vaccines. Their recommendations will also apply to the Vaccines for Children program, which has been highly successful at ensuring children have access to vaccines.

The call for comments can be read here: file:///Users/careycadieux/Downloads/CDC-2025-0454-0001_content%20(1).pdf

Your own comments with a 500 word maximum can be made here: https://www.regulations.gov/document/CDC-2025-0454-0001/comment

It’s important to consider what you want the ACIP to hear; while personal stories may be moving, it’s also appropriate that we include data and factual information in our comments. Start by letting the committee know you are an RN and why you are writing the comment. Include some links to articles or websites to support your ideas. Tell them what you want them to do. Remain professional. Include stats if you find them. Also, my entry is approaching the 5k word limit, but even just a few hundred works can have an impact.

You have the power!

Here is an example I submitted today (at the time of this blog posting it is still awaiting approval).

As a registered nurse with a PhD, an interest in public health, a fellow of the American Nurses Association Advocacy Institute, a Fellow of the American Academy of Nursing, and a background in public policy, I am deeply concerned about the current state of the CDC’s vaccine stance and the next steps for the ACIP. The recent proposal to limit access to the hepatitis B, MMRV, RSV, and COVID vaccines could end up being disastrous for the United States citizens. This is likely to end up costing the country and its citizens greatly on many levels. The ACIP vote, scheduled for September 2025, will, in great part, determine the future of our nation’s health. 

There is a significant public health concern that people, particularly children, should be vaccinated, and that the vaccines be covered by marketplace/ACA insurance, as well as the Vaccines for Children Program. A study performed by the National Institutes of Health with scientists from Henry Ford Health found that the some of the most impactful risk factors for the spread of COVID-19 in households include obesity and children as vectors (Siebold et al., 2022). 

Our public health system needs to vaccinate people to reach and/or maintain herd immunity for many preventable diseases. Herd immunity refers to the evidence-based concept where enough people are vaccinated to prevent the rapid spread of infectious agents. According to the Cleveland Clinic (2022), achieving herd immunity from COVID-19 required vaccination levels of up to 85% of the population, which we failed to achieve; hence, COVID-19 is now considered to be an endemic disease. Restricting access to vaccines contradicts the well-established scientific evidence that vaccines protect populations from infectious diseases, decrease overall healthcare costs, and safeguard vulnerable populations (Ashby & Best, 2021). 

The ACIP must also consider the cost of ongoing vaccine hesitancy and the lack of public health system support for accessing vaccines. A Kaiser Family Foundation study estimated that the cost of 690,000 vaccine-preventable COVID-19 hospitalizations in June-November 2021 was $13.8 billion (Kaiser Family Foundation, 2021). The CDC’s own research has found that the Vaccines for Children Program is effective. From 1994 to 2023, this program prevented 508 million lifetime cases of illness and 32 million hospitalizations, while also saving $540 billion in direct medical costs and $2.7 trillion in societal costs (Zhou et al., 2024). 

Additionally, vaccine-preventable diseases (VPD) in people over age 50 are not just costly; VPD hospitalized patients incurred worse clinical outcomes, greater loss of independence, and increased mortality and morbidity versus control groups (Hartman et al., 2024). The indirect costs of low vaccination rates include lost productivity, increased public health costs, diversion of public health resources, and higher insurance premiums. At a time when societal and US debts are rising at an alarming rate, not supporting access to free vaccines on a clearly defined and evidence-based schedule is an ingredient of a recipe that results in US economic failure.

Instead of focusing on restricting vaccines, the CDC and the ACIP should be focusing on overcoming vaccine hesitancy so that adults and children can be properly vaccinated according to an evidence-based schedule. In the best interest of the health of the US citizens, the proliferation of fear around vaccines needs to come to a halt, and the polarization of vaccine acceptance needs to be rebuked. The CDC needs to overcome vaccine hesitancy by supporting doctors, nurses, and pharmacists in their efforts to educate people about the acceptance of vaccines and their effectiveness at maintaining both individual health and the health of the population. The APIC, by supporting an evidence-based CDC vaccination schedule and a regulatory system that encourages vaccination for children and adults, could address the main components of vaccine hesitancy: lack of confidence in vaccines, complacency, and lack of vaccine access/ convenience (Gregory et al., 2023). The ACIP and CDC should not be creating road blocks around the people’s access to life saving vaccines. 

When considering the moral and ethical implications of vaccine programs and mandates, governments must always prioritize maximizing public benefit and minimizing public harm (Jalilian et al., 2023). The unintended consequences of the ACIP not fully supporting an evidence-based vaccination schedule from the CDC, include increased costs to the system, further division of the US population around this issue, and growing vaccine hesitancy. 

I urge the ACIP to vote in favor of evidence-based decisions regarding vaccine effectiveness and ensuring availability to all people in the population. You are charged with minimizing harm, overcoming vaccine hesitancy, enhancing access to vaccines, and reducing overall costs to the US government and the American people. 

References:

Ashby, B. & Best, B. (2021). Herd immunity. Current Biology, 31(4), R174-R177. https://doi.org/10.1016/j.cub.2021.01.006

Cleaveland Clinic. (2022). Herd immunity. https://my.clevelandclinic.org/health/articles/22599-herd-immunity

Gregory, P., Gill, M., Datta, D., & Austin, Z. (2023). A typology of vaccine hesitancies: Results from a study of community pharmacists administering COVID-19 vaccinations during the pandemic. Research in Social and Administrative Pharmacy, 19(2), 332-342. https://doi.org/10.1016/j.sapharm.2022.09.016

Hartmann, M., Servotte, N., Aris, E., Doherty, T.M., Salem, A., & Beck, E. (2024). Burden of vaccine-preventable diseases in adults (50+) in the United States: a retrospective claims analysis. BMC Public Health 24, 2960. https://doi.org/10.1186/s12889-024-20145-0

Jalilian, H., Amraei, M., Javanshir, E., Jamebozorgi, K., & Faraji-Khiavi, F. (2023). Ethical considerations of the vaccine development process and vaccination: A scoping review. BMC Health Services Research, 23(1), 255. https://doi.org/10.1186/s12913-023-09237-6

Kaiser Family Foundation. (2021). Unvaccinated COVID patients cost the US health system billions of dollars. https://www.kff.org/covid-19/unvaccinated-covid-patients-cost-the-u-s-health-system-billions-of-dollars/


Seibold, M. A., Moore, C. M., Everman, J. L., Williams, B. J. M., Nolin, J. D., Fairbanks-Mahnke, A., Plender, E. G., Patel, B. B., Arbes, S. J., Bacharier, L. B., Bendixsen, C. G., Calatroni, A., Camargo, C. A., Jr, Dupont, W. D., Furuta, G. T., Gebretsadik, T., Gruchalla, R. S., Gupta, R. S., Khurana Hershey, G. K., Murrison, L. B., … HEROS study team. (2022). Risk factors for SARS-CoV-2 infection and transmission in households with children with asthma and allergy: A prospective surveillance study. The Journal of Allergy and Clinical Immunology, 150(2), 302–311. https://doi.org/10.1016/j.jaci.2022.05.0

Zhou, F., Jatalaoui, T.C., Leidner, A.J., Carter, R.J., Dong. X., Santoli, J., Stokely, J.M., Daskalakis, D.C., & Peacock, G. (2024). Health and economic benefits of routine childhood immunizations in the era of Vaccines for Children Program- United States, 1994-2023. MMWR Morbidity & Mortality Weekly Report, 73, 682-685. https://www.cdc.gov/mmwr/volumes/73/wr/mm7331a2.htm

Nurses’ Concerns COVID19: Update March 23,2020. Take Action.

/ Carey S. Clark, PhD, RN, AHN-BC, RYT, FAAN / 2 Comments

Today in social media land, nurses state that they are being told to not use PPE for MRSA and VRE and other contact precaution patient care situations. I think we all know the dire implications around this.

Some are claiming that in other countries they have contacted nurses and doctors who do have access to adequate PPE.

Additionally, many are discussing at what point do you refuse to work because you don’t have proper PPE, or any PPE at all. Some nurses are grateful to be working and still have an income, others are worried and exhausted, some haven’t seen their kids or family in a week out of fear of exposing them to COVID19.

There are private companies that are helping hospitals and healthcare systems access more PPE for their needs. A former state legislator from Maine, Diane Russell, has been working as a broker to help state legislators from Massachusetts to procure PPE. So, instead of the federal government helping to ensure that the people on the front lines are protected, states and healthcare systems are having to turn to private organizations for assistance in just finding PPE: https://www.bostonglobe.com/2020/03/21/metro/message-maine-massachusetts-yields-much-needed-medical-supplies/?  I do not know much about the company, I don’t know if the pricing is fair, but I do know they are able to provide many with PPE. https://noblemedicalsupply.com/products

It’s still early on the east coast, but I am not expecting the president to take action on the Defense Production Act today. I implore you to do the grassroots things and contact our representatives.

Be direct and clear; state your name, where you live, your contact information, your profession, and that you are asking them to ensure that the federal government takes action on the Defense Production Act so that healthcare workers have access to Personal Protective Equipment and patients have access to ventilators.

I suggest both phone and email messaging. I suggest leaving messages with the president’s office, and each of your representative federal lawmakers. It took me about 30 minutes to organize myself, write out my message, and both call and email the president, my governor, my federal legislators.

The full list of how to contact all of your federal and state lawmakers is found here on this main landing page: https://www.usa.gov/elected-officials

This link takes you to your house of representatives legislator and provides phone and email contacts: https://www.house.gov/representatives/find-your-representative

This link takes you to the senator’s contact information: https://www.senate.gov/general/contact_information/senators_cfm.cfm

It’s also important to contact your state government and aks them to request that the federal government take action. You can find your state government links here: https://www.congress.gov/state-legislature-websites and also from the main landing page, including your governor’s information.

*Thanks to those of you who dialogued and posted yesterday, though I haven’t had the energy to respond. I am trying to take good care of myself, as I still have a sore throat, headache, runny nose, body aches, no fever. All of the symptom checkers say it’s not COVID19. I wish you all wellness and peace.

Nurses’ Concerns with COVID19: March 20, 2020

/ Carey S. Clark, PhD, RN, AHN-BC, RYT, FAAN / 7 Comments

Like many of you reading this, I have a range of emotions and feelings as the pandemic of COVID19 grows in the USA: anxiety, fear, and anger. Today (and for the last several days), I am angry about the lack of Personal Protective Equipment (PPE) available for nurses who are being called to care for those who are most ill and the most contagious. The following is my attempt to express my personal concerns and align them with nursing’s guiding ethical principles.

There may be flaws in my thinking and I am open to respectful dialog about these issues. I understand that emotions are running high and that we may not agree, but we can and should have civil discussions and dialogs.

Lack of Personal Protective Equipment. On February 7, 2020, the World Health Organization warned of a shortage of Personal Protective Equipment in China and beyond. As that was 6 weeks ago, there has been time to ramp up the production of PPE. Meanwhile, state’s governors from Maine to Wisconsin to Florida and Washingon are asking to access the federal stockpiles for access to PPE:

https://www.penbaypilot.com/article/governor-mills-urges-federal-government-vice-president-release-personal-protection-eq/131972

https://www.nbc15.com/cw/content/news/Evers-asks-federal-govt-for-much-needed-supplies-from–568975621.html

https://www.propublica.org/article/heres-why-florida-got-all-the-emergency-medical-supplies-it-requested-while-other-states-did-not

https://www.doh.wa.gov/Newsroom/Articles/ID/1117/Addressing-shortages-of-Personal-Protective-Equipment-PPE

Nurses Quitting: A few days ago, one of my Facebook friends quit her job because she was no longer being provided the proper PPE, She was not directly caring for COVID19 patients, but she needs proper PPE to keep herself and her patients safe during the provision of care,  and her quitting her job got me thinking, considering ethical issues, advocacy, the role of the nurse, and so on.  I respect her decision, and I hope this post makes it clear that during these frightening and murky times, the decisions we make as nurses are going to be hard ones.

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I want to say, from an ethical perspective, it is perfectly acceptable for nurses to quit their jobs and/or refuse to work without proper PPE. Refer to my previous post of the ANA calling for the CDC to provide evidence when they make guidelines, and consider the recent use of bandanas and reuse of face masks protocol from the CDC: https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/face-masks.html. This flies in the face of everything we know about the transmission of viruses.

Ethical Principles: The overarching ethical principles at play here that help to guide nurses’ decision making are beneficence (doing the good thing, moral obligation to do the right thing, what is best for the patient) and nonmaleficence (do no harm to patients). When we work without proper PPE, there is a very real risk that not only might we harm ourselves, we potentially spread pathogens to patients. When we don’t have proper PPE, our stress, fear, and anxiety can be magnified and potentially may harm patients.

Additionally, The code of ethics for nurses (https://www.nursingworld.org/coe-view-only) requires a lot of us.  To begin with, we must be deeply familiar with The code and how it guides our decision-making processes. The following are some excerpts from The code that guide our decision making at this time:

The code: 3.5 Protection of Patient Health and Safety by Acting on Questionable Practice 

This concept is all about the reporting of inappropriate and questionable practices. We may become stymied when even our boards of nurses are aware of dangerous and non-evidence-based practices, but they may see no way around them. We can report the issues, but when the governing bodies we report to are not holding up our own ethical standards, the field is put at greater risk for collapse (from infection spreading and/ or providers quitting).

Even as standards are relaxed, entities such as the Oregon Board of Nursing should be taking more responsible action and not placing nurses and patients at risk. The following is a statement by the Oregon Board of Nursing that states that nurses cannot refuse assignments because of sub-par PPE that does not align with CDC or WHO regulations. In other words, in this case, the BON is either not considering the greater harm for both patients and nurses by not recognizing the greater ethical concerns and personal risks nurses are being asked to take, or they simply see no other solutions. The paragraphs about the social contract and evidence-based approaches contradict the highlighted area regarding changes in PPE approaches and the right to refuse assignments.

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Regardless of what our boards of nursing state, Provision 4 makes it clear that we are ultimately responsible for our own practice:  “The nurse has authority, accountability, and responsibility for nursing practice; makes decisions, and takes action consistent with the obligation to promote health and to provide optimal care”. Specifically, Provision 4.1 states that “Nurses bear primary responsibility for the nursing care that their patients and clients receive” and “Nurses must always comply with and adhere to state nurse practice acts, regulations, standards of care, and ANA’s Code…”. This does lead to interesting paradoxical issues with the Oregon Board of Nursing, as one could view this as a regulation, but it contradicts further statements in The code, including:

Provision 4.3: “Nurses are always accountable for their judgment, decisions, and actions: however in some circumstances, responsibility may be borne by both the nurse and the institution. Nurses accept or reject specific role demands and assignments based on their education, knowledge, competence, and experience, as well as their assessment of the level of risk for patient safety. Nurses in administration, education, policy, and research also have obligations to the recipients of nursing care” and “Nurses must bring forward difficult issues related to patient care and/or institutional constraints upon ethical practice for discussion and review”.

Most importantly, The code calls for us to take good care of ourselves so that we can take care of others. We see this shown in Provision 5, particularly:

Provision 5.2 Promotion of Personal Health, Safety, and Well-Being

“…nurses have a duty to take the same care for their own health and safety. Nurses should model the same health maintenance and health promotion that they teach and research, obtain health care when needed, and avoid taking unnecessary risks to health or safety in the course of their professional and personal activities.” The sticking point here is arguing whether or not the risks of not wearing proper PPE, which include risks of death for oneself or other patients who have not yet been exposed, is necessary or not. From my perspective, I can see where working without proper PPE could be too large of a risk to oneself and the communities served.

And I get concerned when nurses seem to think it’s only about them be willing to take on the personal risk for themselves, forgetting about how they may also become the vector.

One last ethical issue, we have to do our own self-care during these challenging times. As nurses, we are required to take care of ourselves. Provision 5.2 continues: “Fatigue and compassion fatigue affect a nurse’s professional performance and personal life. To mitigate these effects, nurses should eat a healthy diet, exercise, get sufficient rest, maintain family and personal relationships, engage in adequate leisure and recreational activities, and attend to spiritual or religious needs…it is the responsibility of nurses leaders to foster this balance within organizations”

Now onto a round-up of current COVID19 issues for nurses as I am seeing on social media:

Masks: Some nurses are being told to store their 1 daily mask in a paper bag and remove/ doff between patients, and replace/don the old mask for new patients. Of course, the bag and the mask would all be potentially contaminated; the bag actually creates a source of contamination and risks for greater transmission. I also heard rumors on social media of nurses being told to share masks, and I am hoping this is simply just false information, as I couldn’t verify that claim. I did hear that eye shields were being shared. I have confirmed that nurses who are normally required to wear masks because they have not been vaccinated for the flu are now being told to not wear masks because there is a shortage of masks. I have also confirmed that having a doctor’s note regarding why one must wear a mask (verification that they are immunocompromised) may work in some settings to either ensure masks are available to the person or excuse them from work.

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We are vulnerable: Nurses are humans and many of us are vulnerable, whether that means we have chronic health conditions and co-morbidities, or we are at risk because of age.

Nurses are also fighting amongst themselves about whether it is okay to quit the workplace now. We have to recognize that these are complex decisions; nurses are real people who have their own health issues. Getting angry about people not willing to take the risk is not productive in both the short and long term.

It’s okay to choose your life and your well-being over the “duty” or social contract to work. It’s okay to make those tough decisions, like quitting your job, and, for some folks, they may be willing to risk their license by refusing assignments where they can’t keep themselves or their patients safe, even if their board of nursing disagrees.

Many nurses will carry on, work hard, provide excellent care, and do their best.

It’s also okay to feel vulnerable and scared in these uncertain times and to question your decisions and the decisions of administrators, regulators, and leaders.

It’s okay to organize and advocate for our needs, whatever that looks like.

Always remember, you have ethics on your side.

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